Computed Tomography Versus Invasive Coronary Angiography in Patients With Diabetes and Suspected Coronary Artery Disease
Authors: Theodora Benedek, Viktoria Wieske, Bálint Szilveszter, Klaus F. Kofoed, Patrick Donnelly, José Rodriguez-Palomares, Andrejs Erglis, Josef Veselka, Gintarė Šakalytė, Nada Čemerlić Ađić, Matthias Gutberlet, Ignacio Diez, Gershan Davis, Elke Zimmermann, Cezary Kępka, Radosav Vidakovic, Marco Francone, Małgorzata Ilnicka-Suckiel, Fabian Plank, Juhani Knuuti, Rita Faria, Stephen Schröder, Colin Berry, Luca Saba, Balazs Ruzsics, Nina Rieckmann, Christine Kubiak, Kristian Schultz Hansen, Jacqueline Müller-Nordhorn, Bela Merkely, Per E. Sigvardsen, Imre Benedek, Clare Orr, Filipa Xavier Valente, Ligita Zvaigzne, Martin Horváth, Antanas Jankauskas, Filip Ađić, Michael Woinke, Niall Mulvihill, Iñigo Lecumberri, Erica Thwaite, Michael Laule, Mariusz Kruk, Milica Stefanovic, Massimo Mancone, Donata Kuśmierz, Gudrun Feuchtner, Mikko Pietilä, Vasco Gama Ribeiro, Tanja Drosch, Christian Delles, Marco Melis, Michael Fisher, Melinda Boussoussou, Charlotte Kragelund, Rosca Aurelian, Stephanie Kelly, Bruno Garcia del Blanco, Ainhoa Rubio, Mihály Károlyi, Jens D. Hove, Ioana Rodean, Susan Regan, Hug Cuéllar Calabria, László Gellér, Linnea Larsen, Roxana Hodas, Adriane E. Napp, Robert Haase, Sarah Feger, Mahmoud Mohamed, Lina M. Serna-Higuita, Konrad Neumann, Henryk Dreger, Matthias Rief, John Danesh, Melanie Estrella, Maria Bosserdt, Peter Martus, Jonathan D. Dodd, Marc Dewey
Journal: Diabetes Care (2023)

OBJECTIVE To compare cardiac computed tomography (CT) with invasive coronary angiography (ICA) as the initial strategy in patients with diabetes and stable chest pain. RESEARCH DESIGN AND METHODS This prespecified analysis of the multicenter DISCHARGE trial (NCT02400229) in 16 European countries was performed in patients with stable chest pain and intermediate pretest probability of coronary artery disease. The primary end point was a major adverse cardiac event (MACE) (cardiovascular death, nonfatal myocardial infarction, or stroke), and the secondary end point was expanded MACE (including transient ischemic attacks and major procedure-related complications). RESULTS Follow-up at a median of 3.5 years was available in 3,541 patients of whom 557 (CT group n = 263 vs. ICA group n = 294) had diabetes and 2,984 (CT group n = 1,536 vs. ICA group n = 1,448) did not. No statistically significant diabetes interaction was found for MACE (P = 0.45), expanded MACE (P = 0.35), or major procedure-related complications (P = 0.49). In both patients with and without diabetes, the rate of MACE did not differ between CT and ICA groups. In patients with diabetes, the expanded MACE end point occurred less frequently in the CT group than in the ICA group (3.8% [10 of 263] vs. 8.2% [24 of 294], hazard ratio [HR] 0.45 [95% CI 0.22–0.95]), as did the major procedure-related complication rate (0.4% [1 of 263] vs. 2.7% [8 of 294], HR 0.30 [95% CI 0.13 – 0.63]). CONCLUSIONS In patients with diabetes referred for ICA for the investigation of stable chest pain, a CT-first strategy compared with an ICA-first strategy showed no difference in MACE and may potentially be associated with a lower rate of expanded MACE and major procedure-related complications.